This invention relates to an orthotic walker, that is to say a device comprising an orthosis for supporting and controlling at least the legs, and optionally also the upper body, of a patient suffering from conditions such as cerebral palsy or other similarly debilitating conditions, and a wheeled frame on which the orthosis is mounted to provide support for the orthosis and the patient.
Existing orthotic walkers have various drawbacks and the object of the invention is to provide an improved orthotic walker having advantages as hereinafter explained.
Terms, such as xe2x80x9ctransverse,xe2x80x9d xe2x80x9clateral,xe2x80x9d xe2x80x9cfrontxe2x80x9d and xe2x80x9crearxe2x80x9d as used herein are, unless the context requires otherwise, intended to indicate a direction relative to a normal walking direction of the device as in use.
According to a first feature of the invention, I provide an orthotic walker comprising an orthosis mounted on a wheeled frame, wherein the wheeled frame comprises a first frame member which extends generally in a direction transverse to the normal walking direction when in use and having thereon attachment means for releasably mounting a support member adapted to carry said orthosis and connection means for the releasable connection of lateral frame members at opposite ends of the first frame member.
The construction of the frame in this way enables different sizes of support member and of lateral frame members to be attached to the first frame member in order to adapt the walker for patients of differing height and/or weight or to adapt to the changing requirements of a growing patient.
In a preferred arrangement the first frame member carries a pair of laterally spaced wheels and said connection means are disposed outwardly thereof, and in this case the lateral frame members each carry a further wheel at or adjacent to the end thereof remote from said connection means.
Further wheels may be castor wheels adapted to swivel about an upright axis, whereas the wheels on or adjacent to the first frame member are preferably non-swivelling. Where such castor wheels are provided, preferably they include adjustable means for restricting the degree of swivelling allowed.
However, it would alternatively be possible for the lateral frame members to carry a respective wheel at or adjacent to the end thereof at which it is connected to the first frame member, in addition to, or instead of, the wheels carried by the first frame member.
The connection means for the lateral frame members conveniently comprises two or more headed studs which project in the transverse direction at each end of the first frame member at equal angular spacings about a transversely extending axis of rotation, and each of said lateral frame members includes a mounting plate having a number of key-hole slots corresponding to said studs, whereby wider end portions of said key-hole slots can be passed over the respective studs and the mounting plate rotated to engage said studs in narrower end portions of said slots.
The wheels carried by, or adjacent to, the first frame member are preferably carried at the outer ends of respective arms at positions spaced from the first frame member in a direction perpendicular to the transverse direction so that when the wheels are engaged with the floor to support the walker a turning moment is applied to the arms, and the arrangement is such that the turning moment acts to assist retention of the studs in the narrower ends of the slots. However, a locking fastener may additionally be provided to hold the mounting plate in assembled relation with the first frame member.
The frame may additionally include a further transversely extending frame member which is releasably connectable to said lateral frame members at or near the ends thereof remote from their connection with said first frame member.
Normally the first frame member will define the rear part of the frame and the lateral frame members will extend forwardly therefrom with the further frame member connected at the forward ends thereof. The releasable connection of the further frame member at the forward side of the frame facilitates the location of the patient in the walker with this frame member removed and subsequently replaced.
In a preferred arrangement, each of the lateral frame members includes a transverse part whereby it is connected to the first frame member and a forwardly extending part. In this way the overall width of the frame can be varied by selecting lateral frame members having a transverse part of differing length.
Whilst it is particularly beneficial for the forward frame member to be releasable, it would alternatively be possible to utilise a single U-shaped frame member instead of separate lateral frame members with a removable forward transverse frame member.
The support member which carries the orthosis may be provided in a range of sizes to suit patients of differing height and weight, and preferably includes a linear suspension unit carried at the upper end of a generally upright arm. The suspension unit may comprise a rod guided for movement in a generally vertical direction under the control of a spring, and the orthosis may be releasably connectable to said rod.
The orthosis may comprise a back member having a mounting means thereon whereby it is releasably connectable to said rod of the suspension unit. The mounting means may be pivotally secured to said back member so as to allow the latter to tilt about a generally horizontal axis and may include a tubular fitting adapted to be engaged slidably over an end portion of said rod.
The back member may carry a pair of lateral arms mounted adjustably thereon, each arm including a transversely extending portion and a forwardly extending portion having a free end at which a respective leg support is pivotably suspended. Such leg supports each comprise an upper element having a pivotal mounting at its upper end whereby it is connected to one of said arms, a lower element having a foot support member at its lower end, and an intermediate pivotal connection whereby the upper and lower elements are connected to one-another.
In accordance with a further feature of the invention, the upper and lower elements of the leg supports are releasably and adjustably secured to the upper pivotal mounting, intermediate pivotal connection and foot support member, so that the effective length of each of said elements can be adjusted independently.
In a preferred arrangement, each of said elements comprises a bar and end portions thereof are connected in overlapping relationship with the upper pivotal mounting, the intermediate pivotal connection and the foot support member as appropriate, for example by means of clamping plates.
The upper pivotal mounting acts as a hip-joint and preferably incorporates means for adjustment of the abduction/aduction angle at the joint. Such means, in accordance with a further feature of the invention, comprises a gimbals assembly including a block mounted for pivotal movement about a first generally horizontal axis and defining a second generally horizontal axis orthogonal thereto, a pivot pin centred on said second axis and carrying said upper pivotal mounting, and adjustment screws carried by said block and engaging with said upper pivotal mounting so as to enable the latter to be set in any of a plurality of positions of angular adjustment relative to a line orthogonal to the first and second axes.
In accordance with a further feature of the invention, the foot support means includes a shoe clamp carried by a pivotal joint with a restricted and adjustable range of pivotal movement to provide control over the degree of dorsiflexion and plantiflexion at the ankle of the user. This joint may comprise an upper arm which is connected to the lower element of the leg support, and lower arm which carries the shoe clamp, and a pivotal connection between said upper and lower arms, wherein the range of pivotal movement is limited and adjustable. The range of movement may be limited by pins which extend through overlapping arcuate slots formed in said arms and the effective length of overlap of said slots is adjustable. In an alternative arrangement, the range of movement permitted to the lower arm relative to the upper arm may be controlled by means of a stop block which is mounted on the upper arm and engages in a recess formed at the upper end of the lower arm to limit angular movement at the joint. The stop block may be adjustable in position relative to the upper arm, for example by being reversible through 180xc2x0 and may have a wider end and a narrower end, either of which can be arranged to engage in the recess so as to provide for two different ranges of movement. It will be appreciated that it would be possible to provide other interchangeable stop blocks to afford different ranges of movement, of to provide a modified stop block with more than two end portions, e.g. three of four, by forming the block with three or four arms.
A further feature of the invention relates to the shoe clamp, which may comprise a mounting arm which is releasably connectable to said lower arm of said pivotal joint at the user""s ankle, a support bar which extends transversely from said mounting arm, a bracket at a free end of said support bar adapted to engage over the welt of a shoe worn by the user, and an adjustable clamp carried by said mounting arm to engage on the welt of the user""s shoe at the side thereof opposite said bracket.
A further form of shoe clamp in accordance with the invention comprises a mounting arm which is releasably connectable to said lower arm of said pivotal joint at the user""s ankle, a support bar which extends transversely from said mounting arm, brackets at opposite ends of said support bar having flanges adapted to engage over the welt of a shoe worn by the user, and an adjustable member carried by said support bar for movement in a direction towards and away from said flanges to clamp against the underside of the user""s shoe.
The invention further resides in a wheeled frame for carrying an orthosis (60) to provide a controlled walking facility when the orthosis is mounted on the frame, wherein the wheeled frame comprises a first frame member which extends generally in a direction transverse to the normal walking direction when in use and having thereon attachment means for releasably mounting a support member adapted to carry said orthosis and connection means for the releasable connection of lateral frame members at opposite ends of the first frame member.
The invention also resides in an orthosis for use with a wheeled frame and having a pair of leg supports each of which includes an upper element having a pivotal mounting at its upper end whereby it is connected to a back support, a lower element having a foot support member at its lower end, and an intermediate pivotal connection whereby the upper and lower elements are connected to one-another, wherein the upper and lower elements of the leg supports are releasably and adjustably secured to the upper pivotal mounting, to the intermediate pivotal connection and to the foot support member, so that the effective length of each of said elements can be adjusted independently.